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cardiac meds
cardiac meds
174
Anatomy
Graduate
05/23/2012

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Term
what does ACE stand for in ACE inhibitors
Definition
angiotensin converting enzyme
Term
what do ACE inhibitors do
Definition
decrease vasoconstriction, thereby relaxing arteries and letting blood flow easier = lower blood pressure
Term
how do ACE inhibitors affect afterload
Definition
decrease afterload by relaxing arteries and reducing pressure
Term
if ACE inhibitors decrease afterload, what does that imply about the amount of blood that leaves the heart
Definition
increases
Term
if ACE inhibitors lead to a greater amount of blood that leaves the heart, how does that affect preload/amount of blood coming into the heart
Definition
increases
Term
what is a side effect of ACE inhibitor, decrease blood pressure
Definition
non-productive dry cough
Term
what are 2 primary disease for which ACE inhibitors are prescribed
Definition
CHF, hypertension
Term
why are ACE inhibitors used for patients with CHF
Definition
so the heart doesn't have to work as hard
Term
what are the steps of the activation of ACE?
Definition
decreased renal perfusion stimulates release of renin from arterioles of glomeruli. Renin formce ACE-I which converts to ACE-II which causes vasoconstriction
Term
what do ACE inhibitors do to inhibit ACE?
Definition
prevent the conversion of ACE I to ACE II
Term
what is the ending of drugs that are ACE inhibitors
Definition
Prils
Term
what are some examples of ace inhibitors
Definition
ramipril, captopril, enalapril, lisinopril
Term
where do ACE I and ACE II functions actually occur
Definition
kidnesy
Term
what do ACE functions affect
Definition
blood pressure
Term
where do ACE inhibitors react
Definition
kidnesy
Term
what do beta blockers do
Definition
block cardiac specific beta receptors of sympathetic nervous system
Term
what is the effect of beta blockers
Definition
decrease blood pressure and heart rate. Anti-arrhythmic because irritation of nerve tissue within the cardiac muscle is decreased.
Term
which part of the heart muscle can depolarize
Definition
any part, but the default is the SA node
Term
if the SA node is not depolarizing properly, how will the heart react
Definition
other parts of the hear twill initiate depolarization, causing arrhythmias/irregular heart rhythms/irregular heart rate
Term
because beta blockers decrease heart rate, what precautions should be taken to exercise a patient on a beta blocker
Definition
don't increase HR more htan 20 over resting HR
Term
what are side effects to watch out for with patients on beta blockers
Definition
hypotension, HR too low
Term
what is it that beta blockers block?
Definition
sympathetic input to the heart
Term
what is the normal affect of sympathetic input on the heart
Definition
increased HR, contractility, and coronary artery dilation
Term
how do beta blockers affect arteries
Definition
dilate/relax them
Term
do beta blockers decrease resting or exercise HR
Definition
both
Term
how do beta blockers affect myocardial oxygen demand
Definition
decrease
Term
what is the ending of drugs that are beta blockers
Definition
olols
Term
what are some examples of beta blockers
Definition
atenolol, metoprolol, propanolol, Carvedilol, Labetalol
Term
can you use the age based HR training range for a patient on a beta blocker
Definition
no
Term
what should be done for a patient on a beta blocker prior to exercising the patient
Definition
exercise test the patient while they are taking the beta blocker.
Term
what do calcium channel blockers do
Definition
block calcium ion influx, thereby inhibiting muscle contraction
Term
what does the lack of muscle contraction in vessels as a result of calcium channel blockers do
Definition
causes vessel dilatoin
Term
how is oxygen demand of the heart changed with calcium channel blockers
Definition
decreased
Term
how is the coronary artery affected by calcium channel blockers
Definition
dilate
Term
how is contractility of the heart affected by calcium channel blockers
Definition
decreased
Term
how does conduction of impulses over AV node change with calcium channel blockers
Definition
slowed
Term
how is heart rate affected by calcium channel blockers and why
Definition
decreased because impulse conduction over AV node is slowed
Term
what are side effects of calcium channel blockers
Definition
peripheral edema, hypotension, headaches
Term
what are the effects of the dilation of vessels caused by calcium channel blockers
Definition
decrease blood pressure and therefore decrease the work of the heart
Term
how do calcium channel blockers affect the oxygen demand of the heart
Definition
decreased because the work of the heart is decreased
Term
do beta blockers or calcium channel blockers slow the conduction of impulses across the AV node and therefore heart rate by a greater amount
Definition
beta blockers slow heart rate more than calcium channel blockers
Term
why do calcium channel blockers cause peripheral edema
Definition
dilation of arteries causes graviational pooling and swelling in hands, feet, abdomen
Term
what are some negative effects of peripheral edema
Definition
neuropathies, clotting, emboli
Term
what do people on calcium channel blockers also often have to take
Definition
diuretics
Term
how is bloodflow to the myocardium affected by calcium channel blockers and why
Definition
increased bloodflow to the myocardium because when the muscle relaxes, it gets better bloodflow
Term
how is afterload affected by calcium channel blockers
Definition
decreased
Term
how are coronary vasospasms affected by calcium channel blockers
Definition
decreased
Term
what are examples of calcium channel blockers
Definition
deltiazem, nifepdipine, verapamil, norvasc
Term
what is verapamil especially good at treating
Definition
controlling SVT = atrial fibrillation/flutter = arrhythmias
Term
what is a side effect of norvasc
Definition
peripeheral edema
Term
why will a patient's exercise performance be slowed with calcium channel blockers
Definition
decreased contractility, decreased HR, decreased cardiac output
Term
how do calcium channel blockers affect supraventricular arrhythmias
Definition
decrease
Term
what do diuretics do
Definition
alter renal function to increase secretion of electrolytes and fluid
Term
what is a result of loss of electrolytes
Definition
muscle cramps
Term
how do diuretics affect the workload on the heart and why
Definition
decrease workload on heart by decreasing total work volume. Heart has to push around less total volume
Term
how do diuretics affect edema
Definition
decrease
Term
how do diuretics affect pulmonary congestion and why
Definition
decrease pulmonary congestion by decreasing fluid in our lungs
Term
how do diuretics affect intravascular volume
Definition
decrease
Term
what are side effects of diuretics
Definition
hearing problems due to ototoxicity, muscle cramps due to loss of electrolytes, urinary incontinence because they have to pee so much, dehydration
Term
what are the 4 types of diuretics
Definition
thiazide, loop, potassium sparing, osmotic
Term
what is the common, first-choice diuretic
Definition
hydrochlorothiazide
Term
what type of diureticis hydrochlorothiazide
Definition
thiazide
Term
what is the problem with loop diuretics
Definition
loop diuretics deplete electrolytes. Often need supplemental K
Term
what type of diuretic is laxis
Definition
loop
Term
is lasix a weak or powerful diuretic
Definition
powerful. Good at getting fluid off quickly
Term
how do diuretics work
Definition
diuretics alter the reabsorption of sodium within the kidneys. Fluid follows the sodium and leaves the body.
Term
what are exercise considerations for patients on diuretics
Definition
possibility of overheating, dehydration, dysrhythmias, hypotension
Term
what is the problem of thiazides when given in high doses
Definition
hyperlipidemia
Term
what do nitrates do?
Definition
relax vascular smooth muscle
Term
what is the influence of nitrates relaxation of vascular smooth muscle?
Definition
causes coronary arteries to dilate, increasing blood flow. Also decreases afterload, thereby decreasing myocardial oxygen demand
Term
what is the name of the nitrate drug
Definition
nitroglycerin
Term
what are side effects of nitroglycerin
Definition
headache, hypotension, skin flushing, light-headedness, nausea and vomiting
Term
when do patients take nitroglycerin
Definition
when they have angina
Term
do coronary arteries fill in diastole or systole
Definition
diastole
Term
how does high diastolic blood pressure affect the filling of the coronary arteries
Definition
high diastolic blood pressure inhibits the filling of coronary arties because it's hard for blood to flow down the arteries when the ventricles are still tense.
Term
why does nitroglycerin cause headaches
Definition
vasodilation of vessels in the brain increases blood volume in the brain
Term
how does nitroglycerin affect blood pressure
Definition
lowers blood pressure because it dilates arteries, creating less resistance to flow
Term
why does skin flushing occur with NTG
Definition
tiny superficial arteries in the skin will open, bringing more blood to the surface of the skin
Term
why does NTG cause light headedness
Definition
initial increase in bloodflow to the brain followed by gravitational pooling in the extremities
Term
why does NTG cause nausea and vomiting
Definition
autonomic response caused by nitrate
Term
how is NTG taken
Definition
under the tongue; don't swallow
Term
what to do if a patient takes NTG
Definition
stay with her, monitor her, prop her feet up, help her to remain comfrotable
Term
what are venous vasodilators
Definition
nitrates
Term
what are arterial vasodilators
Definition
hydralazine, calcium channel blockers
Term
what are combination arterial and venous vasodilators
Definition
nipride
Term
what is another term for myocardial ischemia
Definition
angina pectoris
Term
what situation can cuase angina
Definition
increased oxygen demand or decreased oxygen supply
Term
what things increase oxygen demand
Definition
anything that incrases HR, contractility, myocardial well tension: exercise, heat, cold, shock, hypoxia, anxiety
Term
what things cause decreased oxygen supply
Definition
coronary atherosclerosis or decreased coronary artery filling from aorta
Term
what is coronary atherosclerosis
Definition
plaque formation in the coronary arteries. Can't increase contractility and get blood out to where it needs to go to meet demand
Term
what things decrease coronary artery filling from aorta?
Definition
increased diastolic blood pressure, some arrhythmias
Term
how does increased diastolic blood pressure decrease coronary artery filling from aorta?
Definition
coronary arteries have difficulty perfusing the heart muscle if there is already increased pressure
Term
how do some arrhythmias decrease coronary artery filling from the aorta
Definition
if the heart is not polarizing/depolarizing at a regular interval, its supply will not be met.
Term
what drugs decrease myocardial ischemia by decreasing the demand of oxygen
Definition
beta blockers, calcium channel blockers, nitrates
Term
if a person is taking a beta blocker, a calcium channel blocker, or a nitrate, how will their exercis capacity be affected
Definition
exercise capacity will decrease
Term
what drugs decrease myocardial ischemia by increasing the supply of oxygen
Definition
thrombolytics, anti-platelet agents, anticoagulants, calcium channel blockers, nitrates, oxygen
Term
how do nitrates increase the oxygen supply
Definition
if you have a distal muscle that needs oxygen, you can increase the vasculature going there with nitrates
Term
how do calcium channel blockers increase oxygen supply
Definition
calcium channel blockers cause the muscle to relax a little bit, so the demand from the muscle is not as great. The muscle uses oxygen more efficiently, taking less overall oxygen.
Term
what treatments are given for someone having an MI
Definition
oxygen, morphine, thrombolytics, NTG, stool softeners, aspirin, beta blockers, heparin/lovanox, ACE-inhibitors
Term
why is morphine given for an MI
Definition
reduce pain, help relax, reduce oxygen demand that was increased by stress
Term
why is aspirin given for an MI
Definition
thins the blood
Term
why are thrombolytics given for an MI
Definition
can have a major increase on decreasing damage both from stroke and MI
Term
why is nitroglycerin given for MI
Definition
causes vasodilation, particularly in coronary rteries, allowing coronary arteries to get increased blood volume to the heart muscle
Term
why are beta blockers given for MI
Definition
decrease blood pressure, decrease heart rate = energy conservation
Term
why are heparin/lovanox given for MI
Definition
blood thinners
Term
which blood thinner is often given prophylactically by an injection in the abdomen
Definition
lovanox
Term
how is heparin administered
Definition
by iv or oral form as coumadin/warfarin. Requires monitoring
Term
why are ACE inhibitors used for MI
Definition
reduce vasoconstriction, lower blood pressure
Term
why are stool softeners given for MI
Definition
reduce side effects of other drugs. Valsalva is really bad for heart/lung patients
Term
what do positive ionotropes do
Definition
increase muscle contraction/heart contractility.
Term
what is a positive ionotrope
Definition
a medication that facilitates the heart to beat more powerfully/efficiently/stronger
Term
what are the 2 categories of positive ionotropes
Definition
cardiac glycosides, sympathomimetics
Term
what drug is a cardiac glycoside
Definition
digitalis
Term
what is the main purpose of giving a patient digitalis
Definition
ift he patient has a weak heart muscle, digitalis helps it contract with greater power
Term
what types of patients have weak hearts
Definition
patients with heart failure, history of heart attacks
Term
along with increasing contractility, what is one other benefit of digitalis
Definition
helpful for arrhythmias
Term
what do sympathomimetics do
Definition
acutely increase contractino of the heart
Term
what are some examples of sympathomimetics
Definition
dobutamine, levophed, isuprel, intropine
Term
what will dobutamine do
Definition
increase heart rate
Term
how is dobutamine given
Definition
iv
Term
what are the benefits of digoxin/digitalis
Definition
increases heart muscle contractility, increases exercise tolerance, improves qualtify of life by allowing patients to do more
Term
does digitalis decrease mortality
Definition
no
Term
what are side effects of digitalis
Definition
dysrhythmias, nausea, vision distortion
Term
how are arrhythmias affected by digitalis
Definition
digitalis is a reatment for arrhythmias, but at high doses, digiatlis can cause arrhythmias
Term
what medications are heart failure patients on
Definition
diuretics, ACE inhibitors positive ionotropes, vasodilators, beta blockers
Term
why are heart failure patients on diuretics
Definition
decrease blood volume and therefore decrease blood pressure.
Term
why are heart failure patients on ACE inhibitors
Definition
ACE inhibitors decrease peripheral vascular resistance, thereby decreasing blood pressure
Term
why do we want to decrease blood pressure in a heart failure patient
Definition
decreasing blood pressure keeps the heart from having to work as hard
Term
why do heart failure patients take positive ionotropes like digitalis
Definition
improves contractility
Term
what is linoxin
Definition
another name for digitalis
Term
what does the artery do when you decrease peripheral vascular resistance
Definition
it opens up
Term
how do ACE inhibitors affect arteries
Definition
relaxes the artery, opening it up
Term
how do vasodilators affect arteries
Definition
relax, open arteries
Term
how do beta blockers work in heart failure patients
Definition
beta blockers ease the work of the heart by decreasing sympathetic activation, thereby decreasing heart rate and blood pressure. This is an energy conserving mechanism
Term
do heart failure patients take calcium channel blockers
Definition
no
Term
why don't you give calcium channel blockers to heart failure patients
Definition
calcium channel blockers work on the muscle. They relax the muscle by affecting the calcium exchange. We don't want to promote relaxation of the heart in someone with heart failure. We want the heart to contract harder, more efficiently to better pump blood
Term
how can you increase the strength of the heart in all patients including heart failure patients
Definition
exercise
Term
what is the formula for blood pressure
Definition
BP = CO x PVR
Term
what determines peripheral vascular resistance
Definition
atherosclerosis, blood viscosity
Term
what is a pathology that increases blood viscosity
Definition
polycythemia
Term
what are determinants of blood pressure
Definition
heart rate, stroke volume, peripheral vvascular resistance, blood volume, blood viscosity
Term
what kinds of drugs are anti-hypertensive
Definition
beta blockers, ACE-inhibitors, sympathetic nervous system inhibitors including beta blockers, vasodilators (Venous, arterial, both)
Term
what drugs are given to prevent arrhythmias
Definition
beta blockers, lidocaine, calcium channel blockers, digitalis
Term
how do beta blockers prevent arrhythmias
Definition
by blocking sympathetic stimulation
Term
what type of drug is lidocaine
Definition
refractory period altering drug
Term
what type of arrhythmias is lidocaine helpful for
Definition
ventricular arrhythmias
Term
are ventricular or atrial arrhythmias more dangerous and why
Definition
ventricular arrhythmias are more dangerous because the ventricles do more important work than the atri
Term
what is verapamil
Definition
calcium channel blocker good at treating SVTs
Term
what is an SVT
Definition
supraventricular tachycardia = fast rate in atria such as atrial flutter/fibrillation
Term
what is a membrane potential altering drug
Definition
amiodarone
Term
what type of medicine is amiodoarone
Definition
positive ionotrope
Term
what does amiodarone do
Definition
improves contractility and helps to control arrhythmias
Term
when would a patient be given amiodarone
Definition
if the patient goes into cardiac arrest and has arrhythmias
Term
what is a possible side effect of amiodarones
Definition
ventricular dysrhythmia, lung disease caused by fibrotic changes in the lungs
Term
is amiodarone effective with SVT andVT?
Definition
yes
Term
what does VLDL stand for
Definition
very low density lipoproteins
Term
what are 4 types of meds for lipids management
Definition
fibric acid derivatives, fish oil, HMG-Co A Reductase Inhibitors, Nicotinic Acid
Term
what do fibric acid derviatives do
Definition
decrease triglycerides and VLDL
Term
what do fish oils do
Definition
decrease triglycerides
Term
What do HMG-Co A Reductase Inhibitors do
Definition
decrease LDL, mild increase in HDL
Term
what does nicotinic acid do
Definition
decrease triglycerides and VLDL
Term
what type of drug is niacin
Definition
nicotinic acid
Term
what type of drug is lipitor
Definition
statin = HMG-Co A Reductase Inhibitor
Term
what are some anti-coagulants
Definition
lovanox, coumadin, warfarin, heparin, aspirin, plavix, pradaxa
Term
how is lovanox given
Definition
injected in abdomen prophylactically
Term
how is coumadin/warfarin gien
Definition
p.o,
Term
what must be done with coumadin
Definition
monoitor blood levels
Term
how is heparin administered
Definition
IV
Term
how is aspirin administered
Definition
po usually 81 mg/day
Term
what does plavix do
Definition
discourages platelet aggregation
Term
what is pradaxa used for
Definition
atrial fibrillation
Term
benefit of pradaxa
Definition
less monitoring and dietary restrictions
Term
what is atrial fibrillation and why is it bad
Definition
muscle twitches/vibrates without fully contracting. Affects the output of the atria. Causes increased risk of clot in atria because the atria chamber doesn't efficiently contract to clean out all the blood into the next chamber. Therefore, some of the blood hangs out and clots. This clot could dislodge and go where we don't want it.
Term
what is cardioversion
Definition
like a defibrillator for the atria
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